New Members Survey Form Take a moment to tell us more about yourself… Sponsor Information Sponsor First Name Sponsor Last Name Sponsor E-mail Sponsor Telephone New Member Information First Name Last Name Date of Birth Address 1 Address 2 City State Zip E-mail Telephone Employer / Occupation Hobbies / Interests / Skills / Trades I am interested in getting involved in the following at the Lodge (select as many as you wish). Lodge Committees Accident Prevention Activities Committee Adopt-A-Highway Adopt-A-Family All-American Lodge Americanism Antlers Program Auditing Bar Steward Bell Jar Bingo Chair Camp Bristol Charitable Reporting Christmas Party Cigar Tasting Coats for Kids Community Activities Dart League Diversity Drug Awareness Elks National Foundation Elks Training Entertainment Flag Day Fraternal Fundraising Government Relations Grants Greenbush Award Grounds Hoop Shoot House Chair Indoctrination Internet / Electronic Media Justice Lapsation Liquor Steward Lodge Historian Lottery Major Projects Marketing Meat Raffle Membership Memorial Sunday National Veterans Service Newsletter Editor PER Association Photography Public Relations Recreation Ritual Scholarship Scouting Sickness and Distress Soccer Shoot Steak and Lobster Bake Toys for Tots Trunk or Treat Turkey Bowl Turkey Shoot Welcome Youth Activities Lodge Activities (Check all that apply) Auditing / Financial Bingo Breakfasts / Dinners Bridge / Card Clubs Building Maintenance Bus / Boat Trips Charity Fundraising Conventions’ Decorations Entertainment Elks National Foundation Family Activities Games Greeter Lodge Bulletin Lodge Visitation Membership Parties / Dances Photography Public Relations State Major Project Team Sports Visitation of Sick Other I am interested in serving as a Lodge Officer or Trustee. Yes No Maybe SUBMIT